SSK Little Dragon (LD) Application form

Parents. come along and train.. get fit and learn the skills to benefit you and your child !
(Parents who assisst at LD classes can get discounts and we’ll put your through appropriate Safeguarding and coaching courses)

Teaching Team:
Sifu David Nicholls MSc (Sports & Exercise Science) 6th Degree Black Belt
Sifu & CPO Nic Cumming 3rd Degree Black Belt (Child Protection Officer)
Sifu Jane Anderson 2nd Degree Black Belt
Sifu Emmanuel Nnatuanya 1st Degree Black Belt
Sifu Adam Hawkins 1st Degree Black Belt
Graham Hawkins Brown Belt
Wales:
Sifu Matt Bithel 1st Degree Black Belt
Sifu Leah Roberts 1st Degree Black Belt
Jo Hinchliffe Brown Belt

Please complete SSK membership form and make payment
(for membership and cover to commence) :-

Membership cover is based on continuous payment (classes run all year, excluding 2 weeks Christmas holidays and during competitions – which children can enter).

Membership Application Form

NOTE: If you need to go back, use the 'Back' button at the bottom of the form. NOT 'refresh' or the back arrow on your browser!
(Using '<-' back arrow, may cause the form to add charges when you revisit next section of the form)

‎ Application Type

Please select the correct application type below

Watford Classes Only: Membership(s) & training fees (family discounts available)

Denmark Class

All Other Classes: Membership(s) fees only

Membership for Competitions (Courses) Only

I am a parent (who will not be training) enrolling child/ren

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‎ Parent's Details

Note: fields marked with a red * are required

Parent Title Parent Title

Parent Name

First Name

‎

Surname

Parent Gender

Male

Female

Parent Industry Parent Industry

Parent Email (this will be your online username)

Parent Mobile Number

Parent Address - (child's main residence)

Address Line 1

‎

Address Line 2 (Optional)

Town (Optional)

Country

Post Code

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‎ Member 1's Details

Note: fields marked with a red * are required

1. Title 1. Title

1. Name

First Name

‎

Surname

1. Gender

Male

Female

1. Date of Birth (D.O.B)

1. Industry 1. Industry

1. Email (this will be your online username)

1. Mobile Number

1. Address

Address Line 1

‎

Address Line 2 (Optional)

Town (Optional)

Country

Post Code

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‎ Training and Membership Options

1. Select your main class

(If you are only attending 1 class DON'T select it again on extra classes!)

Add an extra person to your membership

Add 2nd Member

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‎ Member 2

2. Name

First Name

‎‎‎

Surname

2. Gender

Male

Female

2. Date of Birth (D.O.B.)

2. Notes (if any)

2. Main Class

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Add 3rd Member

‎ Member 3

3. Name

First Name

‎‎‎

Surname

3. Gender

Male

Female

3. Date of Birth (D.O.B.)

3. Notes (if any)

3. Main Class

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Add 4th Member

‎ Member 4

4. Name

First Name

‎‎‎

Surname

4. Gender

Male

Female

4. Date of Birth (D.O.B.)

4. Notes (if any)

4. Main Class

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‎ Payment Methods (Standing Order & Internet Banking)

NOTE: Selecting the RECURRING PAYMENT option using Standing Order or Internet Banking. (Lapsed members will be charged a £10 admin fee to rejoin)

TOTAL TO PAY PER MONTH

After clicking on submit you will receive an automatic email containing SO/BACS Banking details

TOTAL TO PAY PER MONTH

After clicking on submit you will receive an automatic email containing SO/BACS Banking details

Your Unique Payment Reference

OLD FORM - Membership type

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‎ Additional Information

How did you hear about this class? How did you hear about this class?

Name of member who introduced you (if any)

(Members may get discounts for introducing people)

Help us to understand your goals

Fight competitively

Learn to defend myself

Keep Fit

Weight Loss

Improve Self confidence

Family Activity

Make new Friends in area

Other (please state what)Other (please state what)

Emergency Contact's Details

Name & Relationship e.g. wife, husband, brother, friend

Emergency Contact's Phone Number

Photograph Permission

I DO NOT want me / my child(ren)s photographs used

Occasionally our instructors take photographs during classes for our website, social media pages (eg Facebook) or posters. Please tick this box if you/your child does not wish to appear in these photographs. (Children’s full names are not included with photographs, unless they won an award – we would contact you, if that occurs)

Any Notes / Comments (120 characters maximum)

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If you are human, leave this field blank.

*On 1 December 2012 the work of the Criminal Records
Bureau (CRB) was merged with the Independent Safeguarding Authority (ISA) to form the Disclosure and Barring Service (DBS).
From 1 December ‘CRB checks’ will be known as ‘DBS checks’.